Effectiveness of structured cardiotocography training on practical performance and fetal trace interpretation among maternity nurses and midwives: a quasi-experimental controlled study

Background Cardiotocography (CTG) is widely used for intrapartum fetal monitoring, but the quality of monitoring depends in part on clinicians’ procedural performance and interpretation of fetal heart rate (FHR) traces. Structured competency-based education may strengthen these measured competencies. Aim To evaluate changes in practical CTG performance and FHR trace interpretation associated with a structured CTG training program among maternity nurses and midwives. Methods A non-randomized controlled quasi-experimental study included 64 maternity nurses and midwives at Al Thaghr General Hospital, Jeddah, Saudi Arabia (32 intervention; 32 control). Participants were allocated using a pre-specified non-random procedure based on duty rosters and clinical work schedules. The intervention comprised three standardized 45-60-minute sessions completed within the three-week intervention period. Outcomes were assessed at baseline, immediately after training, and at three-month follow-up using a 22-item CTG Performance Observational Checklist (0–22) and an 11-item FHR Trace Interpretation Assessment (0–11). Outcome assessors were independent of intervention delivery and blinded to group allocation. Mixed repeated-measures ANOVA tested group, time, and group x time effects; Bonferroni-adjusted pairwise comparisons examined change across time. Results All 64 participants completed all three assessments. Practical performance in the intervention group increased from 10.81 ± 2.16 at baseline to 18.31 ± 1.64 immediately post-training and 17.62 ± 1.70 at three months; the corresponding control-group means were 10.88 ± 2.11, 11.16 ± 2.20, and 10.97 ± 2.29. The group × time interaction was significant, F(2,124) = 712.17, p < .001, partial η² = 0.920. FHR interpretation showed a similar interaction, F(2,124) = 287.80, p < .001, partial η² = 0.823. In the intervention group, both outcomes declined modestly from immediate post-test to three months but remained significantly above baseline (Bonferroni-adjusted p < .001). Conclusion Structured CTG training was associated with substantial improvements in observed CTG performance and FHR trace interpretation, with scores remaining well above baseline at three months despite modest decline from the immediate post-test. The non-randomized allocation, single-center convenience sample, repeated use of the same assessment forms, and absence of maternal or neonatal outcome measures warrant cautious causal and clinical interpretation.